NOTES AND ILLUSTRATIONS.

NOTE I. Chap. i. § 31. p. 45.

Caution or temerity in practice.

IT is the observation of an elegant writer on the subject of morals, and applicable to Medical practice, that"The best character is that which is not swayed by temper of any kind; but alternately employs enterprise and caution, as each is useful to the particular purpose intended. Such is the excellence which St. Evremond ascribes to Mareschal Turenne, who displayed every campaign, as he grew older, more temerity in his military enterprises; and being now, from long experience, perfectly acquainted with every incident in war, he advanced with greater firmness and security, in a road so well known to hima." Yet it is said of the great Duke of Marlborough, that ten years of such uninterrupted and splendid success as no other general could boast of, never betrayed him into a single rash action b.

That boldness in Medical practice is more frequently the antecedent than the consequence of experience, is a melancholy truth; for it is generally founded either on theoretical dogmas, or on pride which disclaims au

a Hume's Inquiry concerning the Principles of Morals, sect. vi. pt. 1. (or Essays, vol. ii. p. 272.)

b See Adam Smith's Theory of Moral Sentiments, pt. vi. sect. 3. vol. ii. P. 158.

thority. To the consideration of Physicians who are thus prematurely confident in their own powers, the remark of Lord Verulam © may be recommended: "This is well to be weighed, that boldness is ever blind; for it seeth not dangers and inconveniences : therefore it is ill in counsel, good in execution: so that the right use of bold persons is, that they never command in chief, but be seconds, and under the di-rection of others. For in counsel it is good to see dangers, and in execution not to see them, except they be very great."

NOTE II. Chap. ii. § 2. p. 48.

Temperance of Physicians.

"THOUGH much has been said, and with some truth, of the good effects of wine in producing rapidity and vivacity of thought, it has scarce ever been pretended that it favoured the exercise of discrimination and judgement. The only persons in whom it has ever been supposed not to have the very opposite effects, are some gentlemen of the Faculty. The ignorant vulgar would think a priori, that, caeteris paribus, a Physician who was sober, would attend more accurately to the case of his patient, and compare and distinguish all circumstances better, and judge more soundly and prescribe more rationally, than he could do when he was drunk. But some Physicians, who should be supposed to know themselves best, and who certainly must have known how they acquitted themc [Essays, § 12. (Works, vol. ii. p. 271.)]

selves in those different situations, have boasted that they prescribed as well drunk as sober. In this they could not be mistaken; for, whether we consider the matter physically or logically, their boast amounts precisely to this, that they prescribed no better when they were sober than they did when they were drunk; which is undoubtedly a noble accomplishment, but it is not surely either wonderful or rared."

Tacitus, in his admirable treatise " De Situ, Moribus et Populis Germaniae," has stated, that those nations "de reconciliandis invicem inimicis, et jungendis affinitatibus, et adsciscendis principibus, de pace denique ac bello, plerumque in conviviis consultant: tamquam nullo magis tempore aut ad simplices cogitationes pateat animus, aut ad magnas incalescat. Gens non astuta nec callida, aperit adhuc secreta pectoris licentia loci. Ergo detecta et nuda omnium mens postera die retractatur; et salva utriusque temporis ratio est. Deliberant dum fingere nesciunt: constituunt dum errare non possunt." (c. 22.)

In deliberation it may on some peculiar occasions be of importance to break off all former strong associations. A fit of drunkenness accomplishes this fully : sleep has the same tendency, and hence the proverb, "I will sleep upon it." But such deliberation bears no analogy to what is required from a Physician, when he is to consider the case of a patient.

d See the Introduction to Philosophical and Literary Essays, by Dr. James Gregory of Edinburgh, p. clxxxvii.

e The learned editor, Lipsius, observes in his note on this passage, "Persarum similis mos, . . . . et Cretensium, .... et Graecorum omnium veterum."

"Universal temperance," says Mr. Gisborne, "both in eating and drinking, is particularly incumbent on a Physician in every period of his practice, not merely as being essentially requisite to preserve his faculties in that alert and unclouded state which may render him equally able at all times to pronounce on the cases which he is called to inspect; but because it is a virtue which he will very frequently find himself obliged to inculcate on his patients, and will inculcate on them with little efficacy, if it be not regularly exemplified in his own conduct."

NOTE III. Chap. ii. § 3. p. 49.

"A Physician should be the minister of hope and comfort to the sick."

66

MR. GISBORNE, in one of his interesting letters to me on the subject of Medical Ethics, suggests, that it would be advisable to add, as far as truth and sincerity will admit. "I know very well," says he, that the sentence, as it now stands, conveys to you, and was meant by you to convey to others, the same sentiment which it would express after the proposed addition. But, if I am not mistaken in my idea that there are few professional temptations to which Medical men are more liable (and frequently from the very best principles,) than that of unintentionally using language to the patient and his friends more encouraging than sincerity would vindicate on cool reflection, it may be

f Duties of Men, chap. 12. vol. ii. p. 150.